Economic impact of epilepsy in the United States

Yoon, Dokyoung; Frick, Kevin D.; Carr, Deborah A.; Austin, Joan K.

doi:10.1111/j.1528-1167.2009.02159.x

Cited by 112 publications

(84 citation statements)

References 27 publications

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“…12 This study also found that for both children and adults, patients with epilepsy were more likely to be uninsured or only have public insurance, which may pose a serious societal burden given the substantial total costs of treating epilepsy. In another survey-based analysis of adult patients, the projected annual cost of epilepsy to society was US $12.5 billion, including direct costs (e.g., medical services, diagnostic procedures, emergency room visits, treatment) and indirect costs (e.g., lost wages), adjusted to 1995 prices.…”

Section: Model Structure and Inputsmentioning

confidence: 75%

Budget Impact Analysis of Antiepileptic Drugs for Lennox-Gastaut Syndrome

Skornicki¹,

Clements²,

O’Sullivan³

2014

JMCP

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BACKGROUND: In October 2011, clobazam was FDA-approved for adjunctive treatment of seizures associated with Lennox-Gastaut syndrome (LGS), a debilitating childhood epilepsy characterized by drop attacks, for patients 2 years and older.OBJECTIVE: To assess the budget impact of adding clobazam to an antiepileptic drug (AED) portfolio containing topiramate, lamotrigine, and rufinamide in a hypothetical, 100,000-member commercially insured health plan.METHODS: Patient characteristics and AED efficacy (decrease in dropseizure frequency) were modeled with clinical data. Medical costs were derived from administrative claims data from a large U.S. managed health plan, with the assumption that 2.3% of drop seizures required medical care. Two-year budget impact was measured. Results were expressed as the overall difference in costs (medical and pharmacy) to a health plan and cost per member per month (PMPM) after addition of clobazam. Analyses of alternative scenarios were performed.RESULTS: With the assumption that 0.04% of the plan population had LGS, adding clobazam to the formulary resulted in cost savings of $98,059 in year 1 and $131,690 in year 2 (savings of $0.08 and $0.11 PMPM, respectively). Analyses of alternative scenarios with lower seizure rates upon discontinuation or greater long-term efficacy for lamotrigine and topiramate did not substantially alter conclusions. The assumption that fewer drop seizures required medical care resulted in a savings of approximately $5,000 per year with clobazam, which suggested that medically attended drop seizures drive costs.CONCLUSIONS: Medically attended drop seizures are a major cost driver for LGS patients. Adding clobazam to a health plan formulary can have a positive overall budget impact through decreased medical costs associated with drop seizures.

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Section: Model Structure and Inputsmentioning

confidence: 75%

Budget Impact Analysis of Antiepileptic Drugs for Lennox-Gastaut Syndrome

Skornicki¹,

Clements²,

O’Sullivan³

2014

JMCP

View full text Add to dashboard Cite

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“…One article estimated direct medical costs in both children and adults in the year 2004, but did not estimate full indirect costs. 30 Assuming static disease prevalence from 2004 to 2014, adjusting to 2014 dollars, and using the Bureau of Labor Statistics medical price index, the direct medical costs of epilepsy for 2014 are estimated at $13.4 billion. 31 However, indirect costs for epilepsy patients are quite substantial, accounting for 66% of total cost for adults, and 20% of total cost for children.…”

Section: Epilepsymentioning

confidence: 99%

The burden of neurological disease in theUnitedStates: A summary report and call to action

Gooch

Pracht

Borenstein

2017

Annals of Neurology

331

219

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“…[1][2][3][4] Several initiatives have demonstrated such reductions may be possible for both adults and children with epilepsy. [5][6][7][8] People with epilepsy at high risk for frequent ED visits are an ideal target group for enrollment in programs to enhance outpatient care, because frequent ED use indicates poor access to care and/or poor disease control.…”

Section: Introductionmentioning

confidence: 99%

Predicting frequent emergency department use among children with epilepsy: A retrospective cohort study using electronic health data from 2 centers

et al. 2017

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SummaryObjective: Among children with epilepsy, to develop and evaluate a model to predict emergency department (ED) use, an indicator of poor disease control and/ or poor access to care. Methods: We used electronic health record data from 2013 to predict ED use in 2014 at 2 centers, benchmarking predictive performance against machine learning algorithms. We evaluated algorithms by calculating the expected yearly ED visits among the 5% highest risk individuals. We estimated the breakeven cost per patient per year for an intervention that reduced ED visits by 10%. We estimated uncertainty via cross-validation and bootstrapping. Results: Bivariate analyses showed multiple potential predictors of ED use (demographics, social determinants of health, comorbidities, insurance, disease severity, and prior health care utilization). A 3-variable model (prior ED use, insurance, number of antiepileptic drugs [AEDs]) performed as well as the best machine learning algorithm at one center (N = 2730; ED visits among top 5% highest risk, 3-variable model, mean = 2.9, interquartile range [IQR] = 2.7-3.1 vs Random Forest, mean = 2.9, IQR = 2.7-3.1), and superior at the second (N = 784; mean = 2.5, IQR = 2.2-2.9 vs mean = 1.9, IQR = 1.6-2.5). The perpatient-per-year breakeven point using this model to identify high-risk individuals was $958 (95% confidence interval [CI] = $568-$1390) at one center and $1086 (95% CI = $886-$1320) at the second. Significance: Prior ED use, insurance status, and number of AEDs, taken together, predict future ED use for children with epilepsy. Our estimates suggest a program targeting high-risk children with epilepsy that reduced ED visits by 10% could spend approximately $1000 per patient per year and break even. Further work is indicated to develop and evaluate such programs. K E Y W O R D Semergency department, epilepsy, health services research, machine learning, pediatrics, predictive modeling

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Economic impact of epilepsy in the United States

Cited by 112 publications

References 27 publications

Budget Impact Analysis of Antiepileptic Drugs for Lennox-Gastaut Syndrome

Budget Impact Analysis of Antiepileptic Drugs for Lennox-Gastaut Syndrome

The burden of neurological disease in theUnitedStates: A summary report and call to action

Predicting frequent emergency department use among children with epilepsy: A retrospective cohort study using electronic health data from 2 centers

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